U.S. ARMY TRAINING AGREEMENT AND PLAN FOR REGISTERED NURSE, GS-610-5/7 TRAINEE TO GS-9

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1 U.S. ARMY TRAINING AGREEMENT AND PLAN FOR REGISTERED NURSE, GS-610-5/7 TRAINEE TO GS-9 1. PURPOSE. To provide for the accelerated development and advancement to GS-9 journey level for nurses entering the Federal service within the U.S. Army at the GS-5 level. This agreement will provide continuity among the nursing staff at our activities by implementing a "grow your own" concept. It will also provide additional entry-level professional nurse opportunities for our staff Licensed Practical Nurses (LPN s) who are pursuing an RN degree. 2. BACKGROUND. The recruitment for Registered Nurses within the Department of the Army has become increasingly difficult. Existing pay disparities compared with local hospitals has necessitated our requests for special salary rates at most of our locations. The use of recruitment and retention bonuses has helped with competitive salaries but has caused dissatisfaction by creating haves and have nots in the workforce. Pay disparities, coupled with the existing national shortage of RN's have caused this problem. In the past we were able to attract and retain experienced RN's at the GS-9 level. With our current and projected nurse shortages we can no longer attract qualified journey level nurses. The situation requires a long-term solution for a source of candidates who will bring continuity and quality patient care. This proposed training plan meets our needs in the following manner: a. This training agreement/plan bridges the gap between the journey RN level of GS-9 and the new graduate level of GS-5. It enables us to hire new nurses and provide them with intensified training tailored to our unique mission and with viable career progression. It will attract nurses into the Department of Army who would not otherwise be interested. b. Accelerated promotion (12-18 months) to the full performance level will help the Department of the Army to retain graduates in the program who otherwise might leave for faster promotions and higher pay at community hospitals. 3. COMPETITIVE SELECTION PROCEDURES. Nurses entering this training program will be competitively selected from public job announcements. 4. RESPONSIBILITIES: 1

2 a. The individual Medical Treatment Facility Department of Nursing is responsible for implementing the provisions of this training agreement, monitoring training progress, documenting successful/unsuccessful completion of training. b. The Civilian Personnel Advisory Center Director or the designated representative is responsible for providing advice and guidance concerning the requirements of this training agreement. c. The trainee is responsible for abiding by the provisions of the training agreement and his/her training plan. 5. STRUCTURE AND LENGTH OF PLAN: a. This plan consists of the following components: (1). Phase I. This phase offers the GS nurse professional assignments that apply routine nursing care and enhance the development of knowledge, skills and abilities to supplement basic preparation in professional nursing. A minimum of six months is required to progress to the GS-7 level. (2). Phase II. This phase will offer the GS nurse professional assignments of moderate difficulty. A minimum of six months is required to progress to the GS-9 level. This phase demonstrates the candidate's ability to perform the major duties of the target grade level. (3). Phase III. This phase is the culmination of the training program. It offers the newly promoted GS-9 nurse additional leadership and training responsibilities that demonstrate the ability to provide patient care with greater autonomy, enhanced critical thinking, and charge nurse opportunities. c. Nurses hired into the Federal service at the appropriate entry level, will successfully complete extensive experience and on-the-job training for promotion to the next grade level within six months. Depending upon the educational level and experience of the trainee, the trainee will normally reach the journeyman level within 12 to 18 months. All participants must meet the Office of Personnel Management Qualification Standard except time-in-grade before promotion. d. Under this agreement the individual s training may be extended for a period determined appropriate by the supervisor for such reasons as lack of progress, illness, or extended leave. This extension is to ensure that the trainee 2

3 fully meets the requirements and learning objectives of the training plan. Trainees who show no potential to progress will be removed from the program. 6. EVALUATION OF TRAINING. The principal method of evaluation will be through supervisory/preceptor review of work, accomplishments, discussion, and formal counseling after the completion of each phase of training. The Nurse Assessment Form will be signed and dated by the evaluator/preceptor. Unsatisfactory progress may require the activity to remove the trainee from the position or from the Federal service. Trainees will be advised that promotions are not automatic and are contingent upon fully meeting all training objectives. 7. PROMOTION CRITERIA. Thirty days before the end of each training phase, the supervisor will certify to the Civilian Personnel Office that the trainee has/has not performed and progressed sufficiently to warrant promotion to the next grade level. The Nurse Assessment Form* will be used as back up to the Request for Personnel Action (RPA) submitted to the Civilian Personnel Advisory Center for processing. * Participants in this training program will be evaluated using the TAPES Senior System. The skills and techniques cited on the Nursing Trainee Assessment Form should be used as performance objectives on the Senior System Civilian Report Support Form. Since the performance of trainees is evaluated at 6-month intervals, the requirement for a probationary appraisal (after 8 months of employment) is waived. 8. PAY RETENTION. Current Department of Army employees who are at or below the GS-9 grade level who voluntary accept a downgrade to enter this program are eligible to retain their current pay in accordance with current Department of Defense pay regulations. 9. CONTINUED SERVICE OBLIGATION. Applicants must sign the enclosed agreement with the Government before entering this program. The employee will agree to (1) continue in the service of his agency at least three times the length of the training period, commencing upon completion of the training, and (2) pay back expenses if he/she voluntarily separates from his agency prior to completion of the service obligation period. 10. CONTINUED USE. The Medical Command will continue to evaluate and document all appropriate labor market conditions, applicant supply file and any other recruitment sources for each grade level to determine the need for the continued use of this training agreement. 3

4 PHASE I - Nurse, GS (Target GS-7) NOTE: At the GS-5 level the nurse will be under close supervision by the preceptor and will be evaluated by the preceptor. WORK RESPONSIBILITIES: 1. Starts work when scheduled and completes work on time. 2. Complies with unit and department scheduling guidelines. 3. Completes hospital, department and/or unit orientation program. 4. Attends unit staff meetings. 5. Coordinates time off with supervisor. 6. Has satisfactory attendance record. 7. Complies with dress code. 8. Maintains Basic Life Support certification. 9. Maintains updated competency record. At the completion of this segment, the nurse will have demonstrated the ability to work in accordance with established hospital and department guidelines. 4

5 PHASE I - Nurse, GS (Target GS-7) WORK RESPOSIBILITIES CONT: 10. Completes orientation including competencybased orientation. 5

6 PHASE I - Nurse, GS (Target GS-7) PERFORMANCE GOALS: 1. Completes written self-evaluation with the assistance of the preceptor. 2. Participates with evaluator in setting realistic, measurable goals for performance. 3. With the assistance of preceptor acquires knowledge and skills to meet goals. Skill in developing realistic performance standards. At the completion of this segment, the nurse will be able demonstrate the ability to set realistic, measurable goals. 6

7 PHASE I - Nurse, GS (Target GS-7) ASSESSMENT: 1. Takes a history utilizing patient/ significant other's input. 2. Recognizes and communicates knowledge of normal versus abnormal findings. 3. Documents accurately and reports pertinent data to preceptor/ Charge nurse. Skill in taking patient histories. At the completion of this segment, the nurse will be able to demonstrate the ability to make accurate observations of patient conditions and record or report these observations. 7

8 PHASE I - Nurse, GS (Target GS-7) PLAN OF CARE: 1. Utilizes input from patient and/or significant others to initiate care plan with guidance from preceptor/or charge nurse. 2. Involves the patient in the plan of care and goal setting. 3. Communicates clearly, the plan of care during the shift report. Skill in developing a patient care plan. At the completion of this segment, the nurse will be able to develop and communicate a comprehensive patient care plan. 8

9 PHASE I - Nurse, GS (Target GS-7) PROVIDES PATIENT CARE: 1. Provides nursing care under direct supervision of preceptor/preceptor. 2. Demonstrates skill in using a variety of specialized medical equipment. 3. Writes clear, concise nursing notes in accordance with policies. 4. Assists in the development of the patient discharge plan. 5. Incorporates steps of the nursing process into the practice of nursing. 6. Appropriately assesses and documents pain; provides pain relief (doctor orders and nursing interventions) reassesses and coordinates additional interventions as needed. 7. Wound Care: assesses wound; performs dressing changes; documents and communicates condition of wound appropriately. Skill in providing nursing care. At the completion of this segment, the nurse will demonstrate the ability to use a variety of skills and equipment to provide effective patient care; document care; initiate discharge planning; assess and manage pain; and provide wound care. 9

10 EVALUATES EFFECTIVENESS OF CARE: PHASE I - Nurse, GS (Target GS-7) 1. With guidance from preceptor assesses and revises the care plan in relation to patient's response to care. 2. Attends patient care /nursing rounds and conferences. Skill in revising patient care plans. At the completion of this segment, the nurse will be able to use input from the patient and other health care team members to evaluate the effectiveness of care. 10

11 PHASE I - Nurse, GS (Target GS-7) COORDINATION: 1. Works cooperatively with health care team members. 2. Identifies own limitations and seeks assistance appropriately. 3. Implements hospital policies and procedures appropriately. 4. Demonstrates competency in problem solving by recognizing and documenting solutions. 5. Assigns priorities related to patient care. Skill in working as a team member. At the completion of this segment, the nurse will demonstrate the ability to function as a full member of the health care team. 11

12 PHASE I - Nurse, GS (Target GS-7) ADMINISTERING MEDICATON AND INTRAVENEOUS THERAPY: 1. Completes pharmacology assessment/testing 2. Prepares medications. 3. Administers medications via multiple routes (oral, rectal, otic, subcutaneous, sublingual, intramuscular, IV piggyback, inhalation, topical, ophthalmic) using appropriate techniques. 4. Properly records drug administration and counsels patient on possible side effects. 5. Correctly disposes of used needles and syringes. 6. Initiates IV using appropriate technique; accurately adjusts flow rate of IV; demonstrates ability to identify signs/symptoms of infiltration and/or infections of IV site and takes appropriate action. 7. Demonstrates knowledge of pharmaceuticals, their desired effects and complication of use. Skill required to provide nursing care to assigned patients. At the completion of this segment the trainee will be able to: Administer prescribed medications and intravenous therapy. 12

13 PHASE I - Nurse, GS (Target GS-7) ADMINISTERING MEDICATON AND INTRAVENEOUS THERAPY CONT: 8. Demonstrates appropriate controlled substance accountability. COMMENTS 13

14 EXAMINATIONS, TREATMENT AND SPECIMENS: PHASE I - Nurse, GS (Target GS-7) 1. Demonstrates ability to collect and process lab specimens including but not limited to blood, urine, stool, sputum, and wound drainage. 2. Interprets and records lab results. 3. Uses lab data to develop and/or modify patient care plan and/or notify charge nurse or preceptor as appropriate. 4. Prepares patient for testing, procedures and examinations. 5. Demonstrates appropriate point of care testing. Skill in collecting and processing specimens. Skill in preparing patients for procedures and examinations. 14

15 NURSING PROCEDURES: PHASE I - Nurse, GS (Target GS-7) Monitoring: 1. Takes and records temperature, pulse, respiration, blood pressure, neurovascular checks, and oxygen saturation using appropriate technique and equipment. Skill in performing various standard nursing procedures. Observe and records vital signs and other pertinent patient parameters. Blood products administration: 2. Demonstrates appropriate techniques for administering blood products including pretransfusion procedures; transfuses blood products and post transfusion procedures; records transfusion appropriately; recognizes and takes appropriate action for transfusion reaction Safely administers blood products. 15

16 PHASE II - Nurse, GS (Target GS-9) PERFORMANCE GOALS: 1. Incorporates change/growth based on evaluation and feedback. 2. Sets realistic, measurable performance goals with assistance of supervisor/preceptor. 3. Demonstrates knowledge needed to meet goals. 4. States understanding of institutional/organizational structure and utilizes appropriate channels of communication. Skill in setting realistic personal goals. At the completion of this segment, the nurse will incorporate realistic, measurable goals for selfperformance. 16

17 UNIT/HOSPITAL RESPONSIBILITIES: PHASE II - Nurse, GS (Target GS-9) 1. Participates in unit staff meetings. 2. Supports unit goals. 3. Documents participation in at least one of the following areas or a comparable area agreed upon with preceptor: Unit/Department committee Nursing research Projects to meet unit goals Performance improvement initiatives Inservices/education presentations 4. Practices effective use of staff and supplies. 5. Understands the process of acquiring drugs, supplies, linen and equipment during normal and after duty hours. Skill in working as a health team member. At the completion of this segment, the nurse will demonstrate the ability to participate in unitbased activities. 17

18 PHASE II - Nurse, GS (Target GS-9) ASSESSMENT: 1. Utilizes advanced interviewing skills. Inservice Skill in interviewing patients. At the completion of this segment, the nurse demonstrates the skill to use interview/assessment data as building blocks for more in depth assessment; builds on initial data. 18

19 PHASE II - Nurse, GS (Target GS-9) PLAN OF CARE DEVELOPMENT: 1. Incorporates interdisciplinary data into the care plan. 2. Formulates plans for teaching and discharge planning. 3. Seeks assistance in using variations in nursing care of patients and evaluates results of intervention. Skill in working as a health team member. At the completion of this segment, the nurse will demonstrate the ability to incorporate input from other health team members in formulating a written plan of care, teaching plans and discharge plans. 19

20 IMPLEMENTATION OF PATIENT CARE PLAN: PHASE II - Nurse, GS (Target GS-9) 1. Provides safe nursing care with indirect supervision. 2. Recognizes changes in patient condition and adjusts care appropriately. 3. Demonstrates knowledge of a wide variety of medical disorders including the normal course of diseases; anticipated complications; and indicated therapeutic interventions. 4. Performs discharge teaching and implements discharge plans. Skill in providing skilled nursing care. At the completion of this segment, the nurse will demonstrate the ability to provide the full range of skilled nursing care to include: Knowledge of a wide variety of medical conditions. Competence in the development of discharge plans. 20

21 EVALUATION AND REVISION OF NURSING CARE PLAN: PHASE II - Nurse, GS (Target GS-9) 1. Participates in patient care/nursing rounds. 3. Communicates reassessment of the patient and revision of the care plan verbally and in writing to other health team members involved in patient care. Inservice Skill in evaluating/revising nursing care plan. At the completion of this segment, the nujrse will demonstrate the ability to: 1. Coordinate nursing care plan with all health team members. 2. Communicate reassessment of the patient and revision of the care plan to other health care team members. 21

22 PHASE II - Nurse, GS (Target GS-9) TEAM LEADER: 1. When serving as a team leader coordinates break and meal times for team members so that adequate coverage on the unit is provided. 2. Makes nursing assignments for team members based on patient acuity and provider skill level; incorporates suggestions from team members concerning patient care. 3. Meets with team members and/or charge nurse to clarify assignments. 4. Makes alterations within team in providing for new admissions, critical patients and/or absence of a team member. At the completion of this segment, the nurse will demonstrate the ability to: 1. Plan and direct the work of teams. 2. Plan individual and special assignments for team members to meet patient and family needs as indicated by the care plan. 3. Maintain close communication with the charge nurse and other team members in all matters relating to patient care. 22

23 COORDINATION AND LEADESHIP CONT: PHASE II - Nurse, GS (Target GS-9) 1. Demonstrates the ability to establish and maintain rapport and working relationships with patients, families, nursing staff, or other members of the health care team and department. 2. Evaluate the quality of care provided by team members and provide appropriate performance feedback to members of the healthcare team. At the completion of this segment the nurse will be ale to provide balanced effective feedback to team members. 23

24 PHASE II - Nurse, GS (Target GS-9) ADVANCED NURSING SKILLS: 1. Closely observes postoperative and seriously ill patients as well as those undergoing therapy for unanticipated reactions and take appropriate action. 2. Identifies major sources of nosocomial infections in patients and describes factors that predispose patients to infections. Discusses the methods of preventing transmission of Lcosocomial infections; implements standard precautions appropriately. 3. Describes the etiology, clinical manifestations and management of the patient. At the completion of this segment, the nurse will demonstrate the ability to provide advanced nursing skills. 24

25 SERIOUSLY ILL AND DYING PATIENTS: PHASE II - Nurse, GS (Target GS-9) 1. Provides appropriate psychological support to patients and significant others. 2. Recognizes deteriorating patients conditions, takes appropriate action and notifies charge nurse and/or physician as appropriate. 3. Manages the dying patient. Inservice At the completion of this segment, the nurse will demonstrate the ability to: 1. Provide comfort and psychological support to seriously ill and dying patients and their family members. 25

26 PHASE II - Nurse, GS (Target GS-9) SELF AND STAFF DEVELOPMENT: 1. Participates in staff development programs. 2. Utilizes opportunities of incidental teaching with staff members (during report, at bedside, during discussions). 3. Assists in orientation of new staff by acting as cocare giver. Skill in performing as a nursing educator. At the completion of this segment, the nurse will demonstrate self-development and will contribute to the development of other staff members. 26

27 PHASE III - Nurse, GS PERFORMANCE: 1. Demonstrates ongoing change and growth. 2. Individually sets realistic, measurable goals for performance. 3. Assumes responsibility for acquiring knowledge to meet goals. 4. Provides appropriate feedback on co-workers to the appropriate supervisor. The nurse will demonstrates individual accountability for personal growth and performance and provides pertinent, appropriate feedback on the performance of team members. 27

28 PHASE III - Nurse, GS UNIT/HOSPITAL RESPONSIBILITIES: 1. Initiates discussion with supervisor regarding issues. Participates in problem solving and follow through. 2. Participates in unit goal setting. 3. Assists in implementing cost effective initiatives. At the completion of this segment, the nurse will demonstrate the ability to: Identify problems, their solutions and take steps to initiate appropriate changes. 28

29 PHASE III - Nurse, GS ASSESSMENT: 1. Differentiates nursing situations and diagnostic data that require priority setting. Responds and/or reports to appropriate health team member. 2. Evaluates assessment data; records and reports interpretation to appropriate health team member. Recognizes and can verbalize knowledge regarding information/situations that require nursing intervention. Skill in assessing nursing situations. At the completion of this segment, the nurse will demonstrate the ability to: 1. Identify nursing situations which require priority setting. 2. Evaluate assessment data; use the data in recording and reporting interpretation to other health care team members. 29

30 PHASE III - Nurse, GS TEACHING AND DEVELOPMENT: 1. Regularly utilizes opportunities for incidental teaching with staff members (i.e. during report, at bedside, during discussions). 2. Assists in orientation of new staff by acting as cocare giver, team leader, charge nurse or preceptor. 3. Guides others in choosing nursing interventions, developing skills, applying knowledge. Skill in teaching and development At the completion of this segment, the nurse will demonstrate the ability to: 1. Utilize opportunities for incidental teaching with staff members. 2. Assist in the orientation of new staff members. 3. Guide others in applying nursing knowledge. 30

31 PHASE III - Nurse, GS COORDINATION AND LEADERSHIP: 1. Establishes priorities in provision of nursing care that reflect consideration of acuity of illness of the patient. 2. Makes nursing assignments based on competency and skill levels of staff members, patient acuity and staff availability. 3. Enforces hospital polices and procedures. 4. Conducts a change of shift report to clarify assignments for all team members. 5. Makes appropriate alterations in providing for new admissions, patient acuity, or absence of a team member. 6. Demonstrates ability to establish and maintain rapport and working relationship with patients, families, nursing staff and other team members of the health care team and department. Acts as Charge Nurse. 31

32 PHASE III - Nurse, GS COORDINATION AND LEADERSHIP (CONT.) 3) Utilizes appropriate written documentation for communication purposes f. Evaluates quality of patient care provided by team members, including students and provides positive and negative feedback to individual members of the team as related to their performance. g. Demonstrates appropriate decision-making; uses resources/support appropriately. 32

33 1. Name SSN 2. Hiring Date: NURSING TRAINEE ASSESSMENT FORM GS-5 3. Evaluation 4. Skills Training Methodology Date: (Check those that apply) Basic Nursing Skills/ General Nursing Techniques Self Assessment 1 - No experience 2 - Proficient Supervisor Rating Interview Demonstration Performance Self- Development A. WORK RESPONSIBILITIES B. PERFORMANCE GOALS C. ASSESSMENT D. PLAN OF CARE E. PROVIDES PATIENT CARE F. EVALUATES EFFECTIVENESS OF CARE G. COORDINATION H. ADMINISTERING MEDICATION/INTRAVENEOUS THERAPY I. EXAMINATION, TREATMENT AND SPECIMENS J. NURSING PROCEDURES SUPERVISOR NAME: SIGNATURE: DATE: 33

34 1. Name SSN 2. Hiring Date: NURSING TRAINEE ASSESSMENT FORM GS-7 3. Evaluation 4. Skills Training Methodology Date: (Check those that apply) Basic Nursing Skills/ General Nursing Techniques Self Assessment 1 - No experience 2 - Proficient Supervisor Rating Interview Demonstration Performance Self- Development A. PERFORMANCE GOALS B. UNIT/HOSPITAL RESPONSIBILITIES C. ASSESSMENT D. PLAN OF CARE DEVELOPMENT E. IMPLEMENTATION OF PATIENT CARE PLAN F. EVALUATION OF NURSING CARE PLAN G. TEAM LEADER H. COORDINATION AND LEADERSHIP I. ADVANCED NURSING SKILLS J. SERIOUSLY ILL AND DYING PATIENTS K. SELF AND STAFF DEVELOPMENT SUPERVISOR NAME: SIGNATURE: DATE: 34

35 1. Name SSN 2. Hiring Date: NURSING TRAINEE ASSESSMENT FORM GS-9 3. Evaluation Date: 4. Skills Training Methodology (Check those that apply) Basic Nursing Skills/ General Nursing Techniques Self Assessment 1 - No experience 2 - Proficient Supervisor Rating Interview Demonstration Performance Self- Development A. PERFORMANCE B. UNIT/HOSPITAL RESPONSIBILITIES C. ASESSMENT D. TEACHING AND DEVELOPMENT E. CHARGE NURSE AND LEADERSHIP SUPERVISOR NAME: SIGNATURE: DATE: 35

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38 Continued Service Agreement For Employees Participating in the Registered Nurse Accelerated Training Plan 1. I understand that participating in the Department of the Army Accelerated Training Plan for Civilian Nurses creates a service obligation for me. I agree to work for the Department of the Army or another Department of Defense component for the time specified below. If I am involuntarily separated from my job, my service obligation ends. 2. I understand that I can go to work for a Government department or agency other than the Department of Defense before my service obligation ends. I agree to give my employing activity at least 10 workdays' notice if I do transfer outside the Department of Defense. If my training was in a non-government facility, the Department must decide within the 10-day period if I have to repay the Government the total costs in item 11h. If I do not give this notice, or if I am notified before transfer that I must repay the costs, I will reimburse the Government the total in item 11h, or the certified actual costs. 3. I understand that if I break this agreement, the Government may withhold money I owe it from money it owes me. The Government can also recover money I owe it in other legal ways. 4. I understand that this agreement does not in any way commit the Government to continue my employment. 5. Employee's name: Job title: Grade, and series: 6. Name of employing activity: Location: 38

39 7. Name and address of training facility: 8. Training period (day, month, year) Starting date Ending date 9. Service obligation period (day, month, year) Starting date Ending date 10. Training costs (not including salary, pay, or compensation): a. Pro rated annual salary of preceptor: b. Other training costs (supplies, books etc.) Total cost of training program: Signature of employee: Date: 39